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Sorbinil and Limited Joint Mobility in Diabetics FREE

Robert N. Frank, MD
JAMA. 1985;254(11):1452-1452. doi:10.1001/jama.1985.03360110042017
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To the Editor.—  The finding of Eaton et al,1 that administration of the aldose-reductase inhibitor, sorbinil, markedly improves joint mobility in the hands of diabetic patients, is of considerable interest. However, I take issue with their suggested explanation, namely, that it is due to reduction of excessive hydration of tendon collagen, produced by decreasing the local concentration of sorbitol.Recently, we2 and others3 have also reported changes in extracellular matrix with marked thickening and other morphological alterations of vascular basement membranes in galactosemic rats. These changes appeared to be identical with the abnormalities seen in diabetic patients, and they could also be prevented by sorbinil. We hesitated to explain these findings using the osmotic hypothesis that has been advanced to explain diabetic and galactosemic cataractogenesis,4 and that, in only slightly varied form, Eaton et al appear to be proposing to explain their results. The reason is

REFERENCES

Eaton RP, Sibbitt WL Jr, Harsh A:  The effect of an aldose reductase inhibiting agent on limited joint mobility in diabetic patients . JAMA 1985;;253:1437-1440.
Frank RN, Keirn RJ, Kennedy A, et al:  Galactose-induced retinal capillary basement membrane thickening: Prevention by Sorbinil . Invest Ophthalmol Vis Sci 1983;;24:1519-1524.
Robison WG Jr, Kador PF, Kinoshita JH:  Retinal capillaries: Basement membrane thickening by galactosemia prevented with aldose reductase inhibitor . Science 1983;;221:1177-1179.
Kinoshita JH, Fukushi S, Kador P, et al:  Aldose reductase in diabetic complications of the eye . Metabolism 1979;;28( (suppl 1) ): 462-469.
Gabbay KH:  The sorbitol pathway and the complications of diabetes . N Engl J Med 1973;;288:831-836.
Jaspan J, Maselli R, Herold K, et al:  Treatment of severely painful diabetic neuropathy with an aldose reductase inhibitor: Relief of pain and improved somatic and autonomic nerve function . Lancet 1983;;2:758-762.
Engerman RL, Kern TS:  Experimental galactosemia produces diabetic-like retinopathy . Diabetes 1984;;33:97-100.

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Eaton RP, Sibbitt WL Jr, Harsh A:  The effect of an aldose reductase inhibiting agent on limited joint mobility in diabetic patients . JAMA 1985;;253:1437-1440.
Frank RN, Keirn RJ, Kennedy A, et al:  Galactose-induced retinal capillary basement membrane thickening: Prevention by Sorbinil . Invest Ophthalmol Vis Sci 1983;;24:1519-1524.
Robison WG Jr, Kador PF, Kinoshita JH:  Retinal capillaries: Basement membrane thickening by galactosemia prevented with aldose reductase inhibitor . Science 1983;;221:1177-1179.
Kinoshita JH, Fukushi S, Kador P, et al:  Aldose reductase in diabetic complications of the eye . Metabolism 1979;;28( (suppl 1) ): 462-469.
Gabbay KH:  The sorbitol pathway and the complications of diabetes . N Engl J Med 1973;;288:831-836.
Jaspan J, Maselli R, Herold K, et al:  Treatment of severely painful diabetic neuropathy with an aldose reductase inhibitor: Relief of pain and improved somatic and autonomic nerve function . Lancet 1983;;2:758-762.
Engerman RL, Kern TS:  Experimental galactosemia produces diabetic-like retinopathy . Diabetes 1984;;33:97-100.
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